1. Good Practice on Scale The past, present and future of Foot and Ankle Pathways in NHS GGC Elaine McLure Nicola Munro David Wylie

2. NHS GGC Foot and Ankle Triage Service Elaine McLure ESP Podiatrist

3. Presentation Outline: Orthopaedic Foot and ankle services in GG&C –Why the need for service change? National Policy and the CCI project Orthopaedic redesign & waiting times Project Aims Public Involvement events Outcomes

4. National policy “ Where ever possible, and it is in the interests of the patient, AHPs should be first point of contact and take the lead in the delivery of the service” Malcolm Chisholm, Minister for health and community care

5. Orthopaedic redesign Traditionally 15% of all orthopaedic referrals are foot and ankle related with an 18 month waiting time. 30% of those go on for surgery 70% are discharged with no surgery

6. Project aims: Reduce the current waiting times for initial consult. Improve the conversion rate for surgery. Provide a more local service.

7. Project aims: Ensure that patients are seen by the most appropriate clinician. Develop service based on public and users involvement. Develop care pathway. Develop highly skilled clinicians.

8. Public Involvement Two public involvement days –Newsletters Comments from event 1 and newsletter 3/2005 Comments from event 2 and newsletter 5/2006

11. Outcomes Waiting times reduced. Conversion rate improved. Local service delivered. Appropriate clinician. ESP training programme developed. Service developed on the PFPI events.

12. This is at the very heart of Delivering for Health and I hope to see more initiatives like this one developing across Scotland. Andy Kerr, Health Minister 2004- 2007( speaking of the foot and ankle triage service in Glasgow) The Foot and ankle triage service won first place at the UK Awards for Allied Health professionals and Healthcare Sciences in London held on 3 November 2005. The project was short listed to 3 from 50 applicants.

13. The commitment by multi professions to improve current service provision. It has delivered a service to a local community normally delivered in hospitals. It has bridged the gap between primary and secondary care (care pathway). It has networked a multidisciplinary team of specialists. What made this project a success?

14. It has increased surgery sessions. It has enhanced the role of the specialist podiatrists. It was built on patient led guidance and continues to develop this way.

15. How was this achieved? Mainly with open shared mentorship. Ability to triage to other services directly. GP meetings. AHP team involvement. Ongoing mentorship.

16. How does this relate with current best practice? Pathway of patient from referral to surgeon is: Quicker –Conservative care is often carried out at source –Assessment,diagnosis and treatment are established at point of contact –Direct access to surgical listing –Direct access to Diagnostics –Direct access for case discussion with consultant

17. Current GG&C Foot and Ankle services 5 ESP podiatrists within the Acute setting: –Glasgow Royal Infirmary (20 sessions) –Western Infirmary (10 sessions) –Southern General/Victoria Infirmary (2 sessions) –Vale of Leven (3 sessions) 2 ESP podiatrists in community: –East Glasgow (10 sessions) –South Glasgow (10 sessions)

18. Patient presentation to GP Orthopaedic Surgeon Assessed by consultant. Orthopaedics Foot and Ankle Triage Service Patient Pathway Referral Guidance Routine Podiatry Referrals All foot /ankle complaints e.g. Corn/callus/nails/plantar fasciitis/metatarsalgia. 1st line treatment of all foot conditions can be treated with appropriate referral to routine podiatry. Biomechanics Clinics All musculo -skeletal conditions e.g. foot/knee/hip, where altered foot posture/gait may be improved via orthoses /exercise programme. Contact Information ESPRoutine Podiatry Orthopaedics Jenny Ackland Project Manager 0141 211 3696 Elaine Yule ESP Podiatrist 0141 232 1553 Ramsay Sloss ESP Podiatrist 0141 531 6810 ESP Podiatrist-Foot and Ankle Triage clinic  Referrals triaged for surgical option.  Care plans advised and referred onto the appropriate health care professional. Urgent referrals to Orthopaedic Department Suspected malignancy, Osteomyelitis,Charcot foot Suspicion of ruptured tendons Foot and Ankle Triage Service. All conditions normally referred to the Orthopaedic department for surgery who are willing to undergo surgery for their complaint. Biomechanics Special attention Acute/active diabetic foot conditions refer directly to the local diabetic service. (see local referral guidelines) Acute/active rheumatoid foot conditions refer directly to the local rheumatology service. (see local referral guidelines)

19. NHS GGC MSK Foot and Ankle Pathways Nicola Munro Project Manager

20. The Story so far Stakeholder engagement –AHP Staff including all levels of all professions –AHP Professional leads –Other Specialities –Other Boards –Patients

21. Goal of Pathways Try to promote equitable and consistent treatment and information for all patients Guide for clinicians to the best evidenced treatment for patients Information on how to refer to other services and the best service to refer to.

22. Clinical Knowledge Publisher http://www.clinicalknowledgepublisher.s cot.nhs.uk/Published/PathwayViewer.as px?fileId=1371http://www.clinicalknowledgepublisher.s cot.nhs.uk/Published/PathwayViewer.as px?fileId=1371

23. MSK Entry Screen

24. Foot and Ankle

25. Area of Presentation

29. First Line Intervention

30. Escalate

31. Second Line Intervention

32. Third Line Intervention

33. Non Evidenced Treatments

34. MD Complex Case Clinic

35. Surgery

36. David Wylie Podiatry Service Manager & Professional Lead Project Sponsor

37. The Future? Implementation Training Evaluation Impact